Provider Demographics
NPI:1821671694
Name:SCOTT-VAN DEUSEN, KAYLEE MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KAYLEE
Middle Name:MARIE
Last Name:SCOTT-VAN DEUSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 BEST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-5507
Mailing Address - Country:US
Mailing Address - Phone:412-999-5695
Mailing Address - Fax:
Practice Address - Street 1:4500 GILBERT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4657
Practice Address - Country:US
Practice Address - Phone:412-999-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist